Nausena Bharti
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10/21/13 Nausena Bharti nausena-bharti.nic.in/reprint_th_officer_multiqual.php 1/1 APPLICATION FORM FOR Permanent Commission (PC) Education Jun 14 BATCH (UNMARRIED MALE/FEMALE C ANDIDATES O NLY) FOR INDIAN NAVY OFFICE USE ONLY CODE NO. VALIDITY STATUS APPLICATION NO-PGD1430411504 Valid Invalid 1. CHOICE OF ENTRY- [2] SSC(LOG) [1] PC(EDU) 2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:- NAME biswajit behera NATIONALITY: INDIAN FATHER'S NAME prakash chandra behera FATHER'S OCCUPATION/DESIGNATION:in govt service as electrician DATE OF BIRTH 1990/05/20 DOMICILE: Orissa GENDER M MARITIAL STATUS:Unmarried 7. ADDRESS: CORRESPONDENCE ADDRESS PERMANENT ADDRESS ADDRESS QR NO-2R-5/13 UNIT-9 FLAT BHOI NAGAR village-baladianuagaon G.P.- BAGHUAPALLI P.S- FATEGARH DIST RICT KHURDA NAYAGARH ST AT E Orissa Orissa PINCODE 751022 752077 TELEPHONE 90 - 40872643 90 - 40872643 MOBILE 9040872643 --NA-- EMAIL [email protected] --NA-- 8.EDUCATION PARTICULARS: 8(a).Qual/Stream/YOP: B.Tech / Instrumentation / 2012 Percentage 86.81% Maximum Marks Marks Obtained Maximum Marks Marks Obtained 1st Semester 10 8.57 2nd Semester 10 9.25 3rd Semester 10 8.52 4th Semester 10 8.89 5th Semester 10 8.84 6th Semester 10 8.42 7th Semester 10 8.39 8th Semester 10 8.57 9. I HAVE NOT ATTENDED ANY SSB TILL TO DATE WITH THE ARMY/NAVY OR THE AIR FORCE. 10.Details of service under central/state Govt. if any (Candidates already in service should apply through proper channel and obtain NOC from the present employer.) Fill NA if not applicable: DECLARATION 1.I, hereby declare that I am unmarried male/female, governed by nationality condition as laid down by the Government of India and have never been debarred from appearing at any examination. I have never been arrested/prosecuted and convicted by a criminal court or involved in any other case registered by the Police. 2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief. 3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me. 4.Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiated against me for fraudulent entry and falsification of GOI documents. I also accept that no TA/DA will be admissible to me in such cases. 5. I have completed my B.Tech as on date. Note: Please forward complete printout of this application duly signed to Post Box No. 04,Chanakyapuri New Delhi- 110021 Place : ...................... Date: .................. Signature of Applicant: ..................................... October 24, 2013, 9:33 am
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Transcript of Nausena Bharti
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10/21/13 Nausena Bharti
nausena-bharti.nic.in/reprint_th_officer_multiqual.php 1/1
APPLICATIO N FO RM FO R Permanent Commission (PC) Education Jun 14 BATCH(UNMARRIED MALE/FEMALE CANDIDATES O NLY)
FO R INDIAN NAVY O FFICE USE O NLY
CO DENO .
VALIDITY STATUS APPLICATIO N NO -PGD1430411504
Valid Invalid
1. CHOICE OF ENTRY- [2] SSC(LOG) [1] PC(EDU)
2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:-
NAME biswajit behera NATIONALITY: INDIAN
FATHER'S NAMEprakash chandrabehera
FATHER'S OCCUPATION/DESIGNATION:in govt service as
electrician
DATE OF BIRTH 1990/05/20 DOMICILE: O rissa
GENDER M MARITIAL STATUS:Unmarried
7. ADDRESS: CORRESPONDENCE ADDRESS PERMANENT ADDRESS
ADDRESSQ R NO -2R-5/13 UNIT-9 FLAT BHO INAGAR
village-baladianuagaon G.P.-BAGHUAPALLI P.S- FATEGARH
DISTRICT KHURDA NAYAGARH
STATE O rissa O rissa
PINCODE 751022 752077
TELEPHONE 90 - 40872643 90 - 40872643
MOBILE 9040872643 --NA--
EMAIL [email protected] --NA--
8.EDUCATION PARTICULARS:
8(a).Qual/Stream/YOP: B.Tech / Instrumentation
/ 2012Percentage 86.81%
Maximum Marks Marks O btained Maximum Marks Marks O btained
1st Semester 10 8.57 2nd Semester 10 9.25
3rd Semester 10 8.52 4th Semester 10 8.89
5th Semester 10 8.84 6th Semester 10 8.42
7th Semester 10 8.39 8th Semester 10 8.57
9. I HAVE NOT ATTENDED ANY SSB TILL TO DATE WITH THE ARMY/NAVY OR THE AIR FORCE.
10.Details of service under central/state Govt. if any (Candidates already in service should apply through proper channel and
obtain NOC from the present employer.) Fill NA if not applicable:
DECLARATION1.I, hereby declare that I am unmarried male/female, governed by nationality condition as laid down by the Government of India and have neverbeen debarred from appearing at any examination. I have never been arrested/prosecuted and convicted by a criminal court or involved in any othercase registered by the Police.2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief.3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me.4.Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiatedagainst me for fraudulent entry and falsification of GOI documents. I also accept that no TA/DA will be admissible to me in such cases.5. I have completed my B.Tech as on date.
Note: Please forward complete printout of this application duly signed to Post Box No. 04,Chanakyapuri New Delhi- 110021
Place : ...................... Date: ..................Signature of Applicant:
.....................................October 24, 2013, 9:33 am
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